Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population

Marco R. Di Tullio, Ralph L Sacco, Robert R. Sciacca, Zhezhen Jin, Shunichi Homma

Research output: Contribution to journalArticle

210 Citations (Scopus)

Abstract

Objectives: We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Background: Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. Methods: The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 ± 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. Results: We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 ± 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). Conclusions: Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

Original languageEnglish
Pages (from-to)797-802
Number of pages6
JournalJournal of the American College of Cardiology
Volume49
Issue number7
DOIs
StatePublished - Feb 20 2007
Externally publishedYes

Fingerprint

Patent Foramen Ovale
Stroke
Aneurysm
Population
Confidence Intervals
Needs Assessment
Echocardiography
Case-Control Studies
Demography

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population. / Di Tullio, Marco R.; Sacco, Ralph L; Sciacca, Robert R.; Jin, Zhezhen; Homma, Shunichi.

In: Journal of the American College of Cardiology, Vol. 49, No. 7, 20.02.2007, p. 797-802.

Research output: Contribution to journalArticle

Di Tullio, Marco R. ; Sacco, Ralph L ; Sciacca, Robert R. ; Jin, Zhezhen ; Homma, Shunichi. / Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population. In: Journal of the American College of Cardiology. 2007 ; Vol. 49, No. 7. pp. 797-802.
@article{f31ac7c524bb404187765a8e0b01db73,
title = "Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population",
abstract = "Objectives: We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Background: Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. Methods: The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 ± 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. Results: We detected PFO in 164 subjects (14.9{\%}); ASA was present in 27 subjects (2.5{\%}) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 ± 28.0 months, an ischemic stroke occurred in 68 subjects (6.2{\%}). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95{\%} confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95{\%} CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25{\%}; adjusted hazard ratio 3.66, 95{\%} CI 0.88 to 15.30). Conclusions: Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.",
author = "{Di Tullio}, {Marco R.} and Sacco, {Ralph L} and Sciacca, {Robert R.} and Zhezhen Jin and Shunichi Homma",
year = "2007",
month = "2",
day = "20",
doi = "10.1016/j.jacc.2006.08.063",
language = "English",
volume = "49",
pages = "797--802",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "7",

}

TY - JOUR

T1 - Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population

AU - Di Tullio, Marco R.

AU - Sacco, Ralph L

AU - Sciacca, Robert R.

AU - Jin, Zhezhen

AU - Homma, Shunichi

PY - 2007/2/20

Y1 - 2007/2/20

N2 - Objectives: We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Background: Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. Methods: The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 ± 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. Results: We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 ± 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). Conclusions: Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

AB - Objectives: We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Background: Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. Methods: The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 ± 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. Results: We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 ± 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). Conclusions: Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

UR - http://www.scopus.com/inward/record.url?scp=33846935025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846935025&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2006.08.063

DO - 10.1016/j.jacc.2006.08.063

M3 - Article

VL - 49

SP - 797

EP - 802

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 7

ER -